Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience

1Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney,
Australia

2Radiofrequency Identification Applications Laboratory, School of Computing and Mathematical Sciences, Auckland University
of Technology, Auckland, New Zealand

Correspondence to Johanna I Westbrook, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Level 1 AGSM
Building, University of New South Wales, Kensington 2052, Sydney, Australia; j.westbrook{at}unsw.edu.au

Accepted 26 May 2011

Published Online First 20 June 2011

Abstract

Background Intravenous medication administrations have a high incidence of error but there is limited evidence of associated factors
or error severity.

Objective To measure the frequency, type and severity of intravenous administration errors in hospitals and the associations between
errors, procedural failures and nurse experience.

Results Of 568 intravenous administrations, 69.7% (n=396; 95% CI 65.9 to 73.5) had at least one clinical error and 25.5% (95% CI
21.2 to 29.8) of these were serious. Four error types (wrong intravenous rate, mixture, volume, and drug incompatibility)
accounted for 91.7% of errors. Wrong rate was the most frequent and accounted for 95 of 101 serious errors. Error rates and
severity decreased with clinical experience. Each year of experience, up to 6 years, reduced the risk of error by 10.9% and
serious error by 18.5%. Administration by bolus was associated with a 312% increased risk of error. Patient identification
was only checked in 47.9% of administrations but was associated with a 56% reduction in intravenous error risk.

Conclusions Intravenous administrations have a higher risk and severity of error than other medication administrations. A significant
proportion of errors suggest skill and knowledge deficiencies, with errors and severity reducing as clinical experience increases.
A proportion of errors are also associated with routine violations which are likely to be learnt workplace behaviours. Both
areas suggest specific targets for intervention.